Cardiovascular disease is a major public health concern in the United States including subclinical diagnoses such as peripheral arterial disease and hypertension. Hispanics comprise the largest minority population in the United States and have been shown to have higher prevalence of cardiovascular risk factors. However, known risk factors (e.g., lipid levels, blood pressure) have been unable to account for all the variability in cardiovascular disease risk and therefore research has expanded into examining environmental factors such as metals as a source of risk. Early epidemiologic and well-established mechanistic evidence suggest that cadmium may be an important risk factor in cardiovascular disease. We propose to conduct a cohort study investigating the association between cumulative cadmium exposure and cardiovascular disease in the San Luis Valley Diabetes Study cohort with longitudinal physiologic and behavioral data. We will estimate cumulative cadmium exposure for individual study subjects using historically collected urine samples. Other pathophysiologic factors will be considered including clinical information, diet, smoking, physical activity, family history, and contributing medical factors. Given the large numbers of Hispanics in the cohort, we will assess whether the relationship between cadmium and CVD varies by white/Hispanic ethnicity for several endpoints. The proposed study will address gaps in understanding of the etiology of cadmium and cardiovascular disease by overcoming several methodological limitations of previous studies related to precision of the exposure assessment and study design. If the study shows an association between urinary cadmium level and cardiovascular disease, it can help elucidate the pathobiology of cardiovascular disease, and aid in prevention by leading to more extensive regulation to avoid population exposure since primary sources of exposure to cadmium are well recognized.